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DTSC 8022A (7/92) <br />EPA 8700-22 Yellow: GENERATOR RETAINS <br />State of„Californio--Environmental Protection Agency „, , , <br />Form Apprti OMB No. 2050-0039 (Expires 9-30.94) WSee Instructions on back We 6. Department of Toxic Substances Control <br />Pie <br />in or type. Form designed for use on elite (12 -pitch) typewriter. Sacramento, California <br />UNIFORM HAZARDOUS <br />1. Generators US EPA ID No. Manifest Document No. <br />2. Page 1 <br />Information in the shaded areas <br />WASTE MANIFEST <br />b30 <br />1 <br />1 <br />isnot required by Federal law. <br />_. of <br />_._ . <br />3. Generator's Name and Mailing Address PACIFIC <br />35 S STOCKTON ST• <br />PO BOX 880 <br />DI CA 9246 <br />toL <br />4. Generator's Phone 209) 334-33524. Gen <br />d <br />5. Transporter 1 Company Name 6. US EPA ID Number <br />O <br />00 <br />SAFETY—KL EEN CORP. 9 2 <br />19F4 1 <br />-J+ <br />V <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />� <br />-C9. <br />z <br />Designated Facility Name and Site Address 10 S P N er <br />SAFETY-�KLE NCORP, 'i�' f _VTj <br />0 <br />5050 SAL.I DA BLVD <br />J <br />SALIDA CA 95369 CAT-' 000613968 <br />U <br />Z <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />12. Containers <br />No. <br />13. Total <br />Type Quantity <br />14: Unit. <br />Wt/V61 . <br />_ <br />Rpt WASTE COMBUSTIBLE LIQUID, N. Q S. <br />DM <br />0 . <br />3 <br />G <br />(PETROLEUM NAPHTHA) NA 1993 PQ 1 I I ( H001) <br />, <br />o <br />E <br />7) 6.7 LBS/GAL <br />0o <br />N <br />b• <br />co <br />E <br />v <br />R <br />A <br />00 :. <br />_T <br />O <br />C. <br />oe <br />R. <br />w <br />1- <br />Z <br />d. <br />LU <br />U <br />LU <br />Z <br />O <br />a <br />(n <br />' <br />LU <br />ceQ <br />Z <br />0 <br />15. Special Handling Instructions and Additional Information LZ <br />EMERGENCY RESP 7'® —88 —466 24HR <br />a <br />Z . <br />_ <br />_ SKDOT# A: 585 B: C. D: <br />1 <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of the consignment are fully and accurately described above by proper shipping name and are classified; <br />J <br />Q <br />packed, marked, and labeled, and are in all res m proper condition for transport b highway according to applicable federal, state and international laws. <br />P _ P� • P Pe P Y g y n9 PP <br />V <br />If I am a large quantity generator, I certify, that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be` <br />'economically practicable and that I have selected the practicable method of treatment, storage, or disposal currently available to me which' minimizes the present and future <br />N <br />threat to human health and the environment; OR, if I am a small quantity generator, 1 have made a good faith effort to minimize my waste generationand select the best <br />waste mona ement method that is available to me and that I can afford. <br />0 <br />P�nti�/Typed Name r <br />Signature <br />Month„,paysar� <br />T <br />1 rams orter 1 Acknowledgement of Receipt of Materials ” <br />Lu <br />0 <br />n <br />fr- <br />Printed/Ty ed Name 4 C <br />: f <br />Signature a° 19 f' / <br />a <br />MonfF�� Day Year - <br />i s t t✓ <br />0 <br />18. Trans orter` Acknowled a ent of Recei t of Materials <br />W <br />T <br />Printed/Typed Name <br />SignatureT <br />Mo1 nth Day Year <br />O <br />R <br />_. <br />N19. <br />Discrepancy Indication Space <br />Q <br />F <br />V <br />A <br />Z <br />I <br />I <br />20. Facility Owner or Operator Certification of receipt of hazardous materials <br />covered by this manifest except as noted in Item 19. <br />T <br />Printed/Typed Name <br />Signature <br />Month Day Year <br />Y <br />DO NOT WRITE BELOW THIS LINE. <br />DTSC 8022A (7/92) <br />EPA 8700-22 Yellow: GENERATOR RETAINS <br />